The Pain Assessment Screening Tool and Outcomes Registry (PASTOR) is a 20-30 minute survey that produces a comprehensive 3-page clinician report of a patient's chronic pain. PASTOR was developed in response to the National Defense Authorization Act (NDAA) 2010 recommendation for “performance measures used to determine the effectiveness of the policy in improving pain care for beneficiaries enrolled in the military health care system.” As a result of the NDAA recommendation the Army Pain Management Task Force was convened to conceive and design an outcomes registry to facilitate pain research and provide clinical outcomes data to improve evidence based decision making by providers.
At its core PASTOR uses instruments developed by the National Institutes of Health (NIH), collectively known as the Patient Reported Outcomes Measurement Information System (PROMIS), to administer questions in a wide range of pain related areas. PROMIS instruments use a technology known as Computer Adaptive Testing (CAT) to administer questions in a way that allows for precision with the fewest possible number of questions. By utilizing CAT through PROMIS, PASTOR is able to obtain scores in pain related areas such as sleep disturbance or physical function in as few as 4-6 questions each without sacrificing the precision of a classic short form.
In addition to the PROMIS instruments, PASTOR also incorporates demographics, the Defense & Veterans Pain Rating Scale (DVPRS), an anatomical map for locating pain areas, military specific pain related questions, and other measures. Taking all of these items and compiling them as one large survey, PASTOR is able to create a comprehensive view of a patient's pain. This information is stored over time and allows the clinician to track a patient's progress to show improvement or decline across multiple measures. The survey is optimized to work on computers, tablets, and smartphones, which enables the patient the flexibility to respond based on their schedule. Patients are enrolled through a participating clinic and all PASTOR data is complied into a 2-page report which is given to the clinician prior to their visit.
To assist in the development of PASTOR, DVCIPM sought help from Northwestern University in Chicago, IL. Northwestern University (NU) is the site of the Statistical Coordinating Center for the NIH’s PROMIS tools. To assist with the implementation of PROMIS tools and measures NU developed the Assessment Center. The Assessment Center is a free online software available to the public at www.assessmentcenter.net. This software facilitates use of PROMIS tools and integrate them with the other questions needed to conduct clinical research. The PASTOR project took this one step further by developing the 2-page PROMIS report for the clinician.
The detailed report graphically demonstrates where and how a patient is experiencing their pain. In addition, the report contains information about three activities that the patient finds important and how pain is directly impacting their ability to perform these activities. Warnings are also included to notify the physician about key concerns such as alcohol or opioid misuse, thoughts of suicide, PTSD, depression, and anxiety. Answers for questions from the DVPRS referencing social function, physical function, and pain interference are charted on to graphs which show a patient's progress over time. For providers: A general overview of the measures contained in PASTOR, as well as their clinical significance can be found here.
Currently PASTOR is available at Walter Reed National Military Medical Center, Madigan Army Medical Center, and Naval Medical Center San Diego, and will soon be rolled out to additional military treatment facilities (MTFs). A view of the patient facing website for DoD sites utilizing PASTOR can be found at www.pastorpatient.com. For providers at MTFs, information on the PASTOR implementation on the Wounded Ill and Injured Registry (WIIR) can be found here.
For information on how to install PASTOR into a local instance of REDCap please visit our GitHub page https://github.com/jpsuen/PASTOR.
By taking the assessment below you acknowledge that this assessment is for demonstration purposes only and should not, under any circumstances, be used on real clinical encounters with patients. This demonstration DOES NOT meet HIPAA requirements. For more information on adapting PASTOR for use in a clinic or a research protocol please contact Christian Calilung.